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The CPT® Code 81261 pertains to the analysis of the immunoglobulin heavy chain locus (IGH@) for gene rearrangement, specifically in the context of leukemias and lymphomas, particularly those of B-cell origin. This molecular genetic testing is crucial for identifying specific gene mutations that may indicate the presence of abnormal clonal populations, which are often associated with various blood cancers. The IGH@ locus is located on chromosome 14 and plays a vital role in the immune response by producing immunoglobulins that recognize foreign antigens. Each immunoglobulin molecule is composed of two identical heavy chains and two identical light chains, which are essential for its function. During the development of B-cells, complete rearrangement of the IGH gene occurs in a stage-specific manner, allowing for the generation of diverse antibodies. The detection of IGH@ gene mutations is significant in the diagnosis and management of blood and lymphatic cancers. The gene rearrangement analysis performed under this code utilizes amplified methodologies, such as polymerase chain reaction (PCR), which is known for its speed, simplicity, and adaptability to various genetic tests. This technique not only aids in the initial diagnosis but can also be instrumental in monitoring treatment responses and predicting disease prognosis. In contrast, other methodologies, such as the Southern blot technique referenced in CPT® Code 81262, involve more complex processes of DNA fragment separation and identification.
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The procedure associated with CPT® Code 81261 is indicated for the following conditions:
The procedure for CPT® Code 81261 involves several key steps to perform the gene rearrangement analysis:
After the procedure associated with CPT® Code 81261, the patient may not require any specific post-procedure care related to the testing itself. However, it is essential for healthcare providers to discuss the results with the patient, as the findings can significantly impact treatment decisions and prognosis. Follow-up appointments may be necessary to monitor the patient's condition and response to any ongoing treatment based on the results of the gene rearrangement analysis. Additionally, healthcare providers should ensure that the results are documented in the patient's medical record for future reference and continuity of care.
| Short Descr | IGH GENE REARRANGE AMP METH | Medium Descr | IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED | Long Descr | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction) | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 234 - Pathology |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | GZ | Item or service expected to be denied as not reasonable and necessary | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2012-01-01 | Added | Added |
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